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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------•----- -------T----- f Permit No. ! 3 /_? ,(Complete in Triplicate) ----__ _ __ _ -_ _________ --_ ------------------- Date Issued ------- - This Permit Expires 1 Year From Date Issued Application is hereby made to!the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules cind Regulations: - CENSUS T RACTJOB ADDRESS/LOCATION ------------- Phone Name ----------- 7, --------- -Address - ----------- city � Contractor's Name __ rte`----------------License # l------- Phone -�� -- Installation will serve: Residence Apartment House❑ Commercial :1 Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:-----r------ Number of bedrooms ----3----Garbage Grinder --------- Lot Size ------ Z3-_______________ Water Supply--,Public System and name -------------------------------------------------------------- s-<-� Private ElCharacter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay'Loam ❑ "k Hardpan ❑ Adobe•(] Fill Materia! ------------ If yes,type ____________________________ (Plot plan, showing size of .lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / r PACKAGE TREATMENT { ] SEPTIC TANK Size___- ______X � H __________________________ Liquid Depth __��____1.__....__ tA ell7� i Capacityl/?� __ , Type _ _______ ________ Material_c s�_7!C. �_- No. Compartments .-:__-. Distance to nearest:'Well ___.____________________________Foundation ---l-C.__----------- Prop. Line ------- LEACHING LINE � No:-of}Lines'_.-______' ___________ Length of each lin e------YQ___._----- Total Length Z_��...._-_...__ ---- ------- 'D' Box._._Ll�-: Type Filter Material __ ___ _____ _____Depth Filter Material ___1__St' _____ Distance 'to nearest: Well _______________________ Foundation -----L()------------- Property Line ._ .___--....._______- SEEPAGE PIT [ ] Depth :--- ---_---------- Diameter ________________ Number ---------------------------- Rock Filled Yes EJNo C]Water Table °Depth ------ --------------------------------- ------Rock Size ------------------------------ a _ Distance to nearest: Well -------------------------------------------Foundation -__________ ------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date ----________________:______•-__-__1 Septic Tank (Specify Requirements) ------------------- -- ------------------------- ---------------------------------- ------------------------..__,---------------------------- Disposal Field (Specify Requirements) -------------------------- - - ------------------------------h' ' --------------------------------------------•------------ -� ---------- n <. . ------------------- ---------'-- ------------------------------------- ---------------------------- (Draw existing and required addition on reverse side)_ , I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the San Jdaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner ' as to become subject to Workman's Compensation laws of California." Signed ------------------------------- ----- - - ---- - ------------------------------------ Owner By ----------- ----- ` ' ------ Title .------- '----------------------------- ------------------- - -- --------- --------- --- - - (If other t n owner) FOR-_DEPAitTM.ENT USE O_ NLY APPLICATION ACCEPTED BY --------- -------- ---- ----------- -------- ------ DATE -------------------° -_= BUILDING PERMIT ISSUED ------------------- ---- -` ----------------------------------------DATE -- ---- -- -------------------------------- - ------------COMMENTS -------------------- _ _f - ____A_3_____ ___ ________ _ __s_____ ------------------ ----- --------- _-------- -.1 -------- - --- --------- --------------------- �P�.eF. ---------------------------- ----- ---- --- ---- --- --------- -- --------- --------- ---- - -------- -------------------------------- ....... Final Inspection ------ - -------- --Date Z ,7- ------- SAN JOAQUIN LOCAL HEXLTH DISTRICT E. H. 9 1-'68 Rev. 5M. [,��-